What is it?

Lactobacillus is a type of bacteria. There are lots of different species of lactobacillus. These are "friendly" bacteria that normally live in our digestive, urinary, and genital systems without causing disease. Lactobacillus is also in some fermented foods like yogurt and in dietary supplements.

Lactobacillus is taken by mouth to treat and prevent diarrhea, including infectious types such as rotaviral diarrhea in children and traveler's diarrhea. It is also taken by mouth to prevent and treat diarrhea associated with using antibiotics.

Some people take lactobacillus by mouth for general digestion problems, irritable bowel syndrome (IBS), colic in babies, inflammatory bowel disease (IBD), inflammation of the colon, too much bacterial growth in the intestines, constipation, to improve outcomes after bowel surgery, and to prevent a serious gut problem called necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus is also taken by mouth for infection with Helicobacter pylori, the type of bacteria that causes ulcers, and also for other types of infections including urinary tract infections (UTIs), vaginal yeast infections, to prevent the common cold and flu, to prevent ear infections in children, and to prevent respiratory infections in children attending daycare centers and in children with cystic fibrosis. It is also taken by mouth for weight loss, rheumatoid arthritis, dental cavities, dental plaque, gum disease, and mouth sores. It is also being tested to prevent serious infections in people on ventilators.

Lactobacillus is taken by mouth for skin disorders such as fever blisters, canker sores, and acne. It is also used to treat or prevent eczema (allergic dermatitis), sensitivity to sun exposure (polymorphous light eruption), sensitivity to environmental allergens, and hay fever in infants and children.

It is also taken by mouth for high cholesterol, swine flu, HIV/AIDS, lactose intolerance, Lyme disease, hives, to prevent cancer, and to boost the immune system.

Likely effective for...

Diarrhea in children caused by a certain virus (rotavirus). Children with rotaviral diarrhea who are being treated with Lactobacillus seem to get over their diarrhea about a half day earlier than they would without this treatment. Larger doses of lactobacillus are more effective than smaller ones. At least 10 billion colony-forming units during the first 48 hours should be used.

Possibly effective for...

Hayfever. Taking two billion colony-forming units of Lactobacillus paracasei daily for 5 weeks can improve quality of life by almost 18% in people with grass pollen allergy that doesn't respond to the anti-allergy drug loratadine. Also, taking 10 billion colony-forming units of Lactobacillus johnsonii for 12 weeks seems to improve itchy eye symptoms in children with allergies that persist throughout the year.

Preventing diarrhea caused by antibiotics. Research suggests that taking probiotics products containing only Lactobacillus strains reduces the risk of diarrhea caused by antibiotics. Also, giving children Lactobacillus GG (Culturelle) along with antibiotics seems to reduce diarrhea. There is conflicting evidence about the effects of Lactobacillus when taking together with other probiotics strains.

Eczema (atopic dermatitis). Most research suggests that Lactobacillus products are beneficial for TREATING eczema. Lactobacillus GG seems to reduce symptoms of eczema in infants who are allergic to cow's milk. Lactobacillus sakei, Lactobacillus plantarum, and a combination of freeze-dried Lactobacillus rhamnosus and Lactobacillus reuteri also seem to reduce eczema symptoms in children ages 1 to 13 years. But Lactobacillus paracasei doesn't seem to be beneficial for treating eczema. Research on the effects of Lactobacillus for PREVENTING eczema is inconsistent. Some research suggests that taking Lactobacillus during pregnancy reduces the risk of eczema in infants. But other research suggests no benefit. This might be due to the strains of Lactobacillus used and how at risk the infants were for developing the skin condition.

A condition associated with an increased risk for developing allergic reactions (atopic disease).. Research suggests that taking Lactobacillus might prevent the development of atopic disease, but only certain Lactobacillus strains seem to reduce the risk. A specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle), taken by mouth 2-4 weeks before delivery and continued for the first three to six months of breast-feeding seems to prevent atopic disease (asthma, allergic rhinitis, and eczema) in infants with a family history of this condition. But other strains do not seem to have the same effect.

Preventing diarrhea due to cancer treatment (chemotherapy). A chemotherapy drug called 5-fluorouracil can cause severe diarrhea and other gastrointestinal (GI) side effects. There is some evidence that patients with cancer of the colon or rectum have less severe diarrhea, less stomach discomfort, shorter hospital care, and require fewer chemotherapy dose reductions due to GI side effects when they take a particular strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle).

Diarrhea. Giving a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) to infants and children 1 to 36 months old when they are admitted to the hospital seems to reduce the risk developing diarrhea. Also, Lactobacillus GG can reduce the risk of diarrhea from all causes in undernourished children. But Lactobacillus GG does not seem to reduce how long otherwise healthy children experience diarrhea, suggesting that it might help prevent but not treat diarrhea. Some research suggests that consuming a specific product containing Lactobacillus casei (DanActive, Dannon) might help prevent diarrhea in children. But other research shows no preventative effect. A specific product containing Lactobacillus reuteri (BioGaia drops, BioGaia AB, Sweden) seems to help reduce the duration of diarrhea in children hospitalized with diarrhea.

Helicobacter pylori (H pylori) infection. Research suggests that taking Lactobacillus can help treat stomach ulcers caused by H. pylori when taken along with "triple therapy" that consists of clarithromycin, amoxicillin, and a proton-pump inhibitor. It does not seem to help treat the infection when taken alone, with only an antibiotic, with other "triple therapies", or with "quadruple therapy" that includes bismuth.

High cholesterol. Eating yogurt or taking capsules containing the Lactobacillus strain L. reuteri NCIMB 30242 (Cardioviva, Micropharma Limited) seems to reduce low-density lipoprotein (LDL or "bad") cholesterol by about 9% to 12% in adults with high cholesterol. Also, taking Lactobacillus plantarum also seems to reduce total cholesterol levels by 14% in adults with high cholesterol. But Lactobacillus does not seem to improve high-density lipoprotein (HDL or "good") cholesterol or triglycerides.

Colic in babies. Taking a specific Lactobacillus reuteri product (Probiotic Drops, BioGaia AB) 100 million CFUs once daily for 21-28 days reduces daily crying time in nursing infants. Some research suggests that taking this Lactobacillus reuteri product seems to be more effective than using the drug simethicone. But a more recent study suggests that it does not reduce crying. It's possible that infants in the recent study had more severe colic than those in the earlier research.

Inflamed mouth sores from cancer treatment (oral mucositis).Research suggests that taking lozenges containing Lactobacillus brevis from the first day of radiation/chemotherapy treatment until one week after reduces the number of patients who develop severe mouth sores.

Inflammation of an artificial rectum surgically created in people with inflammatory bowel disease (pouchitis).Taking Lactobacillus by mouth seems to help treat pouchitis, a complication of surgery for ulcerative colitis. Taking a specific formulation of Lactobacillus, Bifidobacterium, and Streptococcus (VSL#3) for one year seems to maintain remission in 85% of people with this condition. Taking a different formulation containing two Lactobacillus species and Bifidobacterum for 9 months seems to reduce pouchitis severity.

Lung infections. Children ages 1 to 6 years who attend daycare centers seem to get fewer and less severe lung infections when given milk containing Lactobacillus GG or a specific combination product containing both Lactobacillus acidophilus and Bifidobacterium (HOWARU Protect).

Rheumatoid arthritis (RA). Research shows that taking a specific strain of Lactobacillus casei for 8 weeks reduces tender and swollen joints in women with rheumatoid arthritis.

Preventing diarrhea due to traveling. Traveler's diarrhea is caused by bacteria, viruses, or parasites that the traveler has not been exposed to before. Taking a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) seems to help prevent diarrhea in travelers. The effectiveness of Lactobacillus GG can vary a lot depending on the travel destination because of differences in bacteria in different locations.

Treating a bowel condition called ulcerative colitis.. Some research suggests that taking a specific combination product containing Lactobacillus, Bifidobacterium, and Streptococcus (VSL#3) might improve symptoms in people with ulcerative colitis. Continuous treatment for one year seems to help most patients. Taking another specific product containing Lactobacillus plantarum 299v (Profermin, Nordisk Rebalance) also seem to improve symptoms.

Possibly ineffective for...

Treating diarrhea caused by the bacterium Clostridium difficile. Research suggests that taking Lactobacillus GG is not effective for the prevention of Clostridium difficile diarrhea. Taking other Lactobacillus species, including Lactobacillus casei Shirota, Lactobacillus acidophilus, and other strains of Lactobacillus rhamnosus, also does not appear to be effective for preventing Clostridium difficile infections when taken with antibiotics.

Crohn's disease. Some research shows that taking specific strains of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) and Lactobacillus johnsonii does not seem to prevent Crohn's disease from coming back after surgery.

Dental plaque. Giving Lactobacillus reuteri to mothers starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, does not seem to reduce dental plaque in the baby teeth of the child by the age of 9 years.

Necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus GG does not seem to prevent necrotizing enterocolitis in very small babies. Also, giving Lactobacillus reuteri or a specific product containing a combination of Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus plantarum, Bifidobacterium infantis, and Streptococcus thermophilus (Laboratorio Italmex SA, Mexico City, Mexico) to very small infants does not reduce the risk of death or NEC.

Ear infection. Research suggests that taking a specific formula (NAN 3 formula, Nestle Baby) containing Streptococcus thermophiles, Streptococcus salivarius, and Lactobacillus rhamnosus, together with the prebiotics raftilose and raftiline for 12 months, does not reduce the risk of ear infections in healthy infants.

Vaginal yeast infections after taking antibiotics. There is evidence that taking Lactobacillus by mouth or eating yogurt enriched with Lactobacillus doesn't prevent vaginal yeast infections after antibiotics. However, women with yeast infections who use vaginal suppositories containing 1 billion live Lactobacillus GG bacteria twice daily for 7 days in combination with conventional treatment often report their symptoms improve.

Insufficient evidence to rate effectiveness for...

Acne. Taking Lactobacillus and other probiotics by mouth together with antibiotics might improve acne. Early research shows that taking a specific product containing Lactobacillus acidophilus, Lactobacillus bulgaricus, and Bifidobacterium bifidum (Trenev Trio/Healthy Trinity, Natren, Westlake Village, CA) twice daily along with minocycline once daily in the evening for 12 weeks improves acne.

Common cold. Early research suggests that taking Lactobacillus plantarum and Lactobacillus paracasei daily for 12 weeks might reduce the risk of common cold by about 12% and reduce the number of days with symptoms from 8.6 to 6.2 in adults. Also, taking a combination of Lactobacillus acidophilus and Bifodobacterium for 3 months seems to reduce school absences due to cold symptoms. However, research is inconsistent. Taking Lactobacillus helveticus daily for 6 weeks does not seem to reduce the number of cold/flu days in otherwise healthy adult students. Also drinking a beverage containing Lactobacillus brevis does not seem to reduce the risk of catching a cold.

Constipation. Lactobacillus might reduce constipation when taken in combination with other probiotics. But not all combinations help. Taking specific products (Hexbio or Lactofos), which contain fructooligosaccharide, Lactobacillus, and Bifidobacterium, reduces constipation in adults. But eating a yogurt containing polydextrose, Lactobacillus acidophilus, and Bifidobacterium lactis does not reduce constipation. The effects of Lactobacillus alone are unclear.

Cystic fibrosis. Research suggests that taking Lactobacillus reuteri daily for 6 months reduces the percentage of cystic fibrosis patients with lung complications from 37% to 3% and the percentage with upper respiratory tract infections from 20% to 3%.

Dental cavities. Research on the effects of Lactobacillus on dental cavities is mixed. Giving Lactobacillus reuteri to mothers starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, seems to reduce cavities in the child's baby teeth. But giving infants a cereal containing Lactobacillus paracasei (Semper AB, Stockholm, Sweden) from 4 months until 13 months of age does not reduce cavities in baby or permanent teeth.

Stomach pain. Early research suggests that taking Lactobacillus reuteri twice daily for 4 weeks can reduce the severity but not frequency of stomach pain in children 6 to 16 years-old. Other early research suggests that taking Lactobacillus acidophilus and Bifidobacterium lactis twice daily for 30 days improve stomach pain.

Flu. Taking a probiotic test drink (Kagome, Nagoya, Japan) containing Lactobacillus brevis five days weekly for 8 weeks reduces the incidence of the flu in schoolchildren during flu season. But taking Lactobacillus helveticus daily for 6 weeks does not seem to reduce the number of cold/flu days in otherwise healthy adults.

Lactose intolerance. Research on the effects of lactobacillus on lactose intolerance is conflicting. Some research shows that drinking Lactobacillus acidophilus milk produces the same symptoms of intolerance as regular cow's milk in people with lactose intolerance. But other research shows that drinking a milk product containing Lactobacillus bulgaricus reduces symptoms of lactose intolerance.

Growth of bacteria in the intestines. Some clinical research has evaluated lactobacillus for treating and preventing growth of potentially harmful bacteria in the intestines. Some of this research shows modest improvements in symptoms of stomach pain, bloating, and diarrhea; however, other research has found no benefit in people with bacterial overgrowth. Lactobacillus does not seem to be helpful for preventing growth of harmful bacteria in the intestines.

Urinary tract infections (UTIs). There is some early evidence that vaginal use of some Lactobacillus species might be helpful for preventing UTIs, but not all studies have agreed. There is also conflicting evidence about the effects of taking Lactobacillus by mouth.

Pneumonia in people on breathing machines in the hospital. Early research suggests that taking Lactobacillus rhamnosus GG (Culturelle) twice daily might reduce the incidence of pneumonia in people in the intensive care unit.

Weight loss. Research suggests that taking Lactobacillus rhamnosus twice daily for 24 weeks does not reduce body weight or fat mass in obese adults. But when only considering its effects in women, Lactobacillus rhamnosus does seem to reduce body weight.

Boosting the immune system.

Cancer.

Canker sores.

Fever blisters.

Hives.

Lyme disease.

Other conditions.

More evidence is needed to rate lactobacillus for these uses.

How does it work?

Many bacteria and other organisms live in our bodies normally. "Friendly" bacteria such as Lactobacillus can help us break down food, absorb nutrients, and fight off "unfriendly" organisms that might cause diseases such as diarrhea.

Are there safety concerns?

Lactobacillus is LIKELY SAFE when taken by mouth appropriately. Side effects are usually mild and most often include intestinal gas or bloating.

Lactobacillus is also LIKELY SAFE for women to use inside the vagina.

Special precautions & warnings:

Children: Lactobacillus is LIKELY SAFE when taken by mouth appropriately in children. Lactobacillus GG, a specific strain of Lactobacillus rhamnosus, has been used safely from five days to 15 months.

Pregnancy and breast-feeding: Lactobacillus is POSSIBLY SAFE when taken by mouth appropriately while pregnant and breastfeeding. Lactobacillus GG has been used safely in pregnant and breast-feeding women. The combinations of Lactobacillus rhamnosus or Lactobacillus paracasei with Bifidobacterium longum from 2 months before delivery until the breastfed infant was 2 months has been used safely. But other types of lactobacillus have not been studied during pregnancy and breast-feeding, so their safety is unknown.

Digestive surgery: There is some concern that eating a yogurt containing Lactobacillus might cause a bacterial infection following a colonoscopy. Stop taking probiotics before a digestive surgery or colonoscopy.

Weakened immune system: There is some concern that lactobacillus from supplements that contain live bacteria might grow too well in people whose immune systems are weakened. This includes people with HIV/AIDS or people who have taken medicines to prevent rejection of a transplanted organ. Lactobacillus has caused disease (rarely) in people with weakened immune systems. To be on the safe side, if you have a weakened immune system, talk with your healthcare provider before taking lactobacillus.

Short bowel syndrome: People with short bowel syndrome might be more likely than other people to develop lactobacillus infections. If you have this condition, talk with your healthcare provider before taking lactobacillus.

Are there interactions with medications?

Moderate

Be cautious with this combination.

Antibiotic drugs

Antibiotics are used to reduce harmful bacteria in the body. Antibiotics can also reduce friendly bacteria in the body. Lactobacillus is a type of friendly bacteria. Taking antibiotics along with Lactobacillus can reduce the effectiveness of Lactobacillus. To avoid this interaction, take Lactobacillus products at least 2 hours before or after antibiotics.

Minor

Be watchful with this combination.

Medications that decrease the immune system (Immunosuppressants)

Lactobacillus contains live bacteria and yeast. The immune system usually controls bacteria and yeast in the body to prevent infections. Medications that decrease the immune system can increase your chances of getting sick from bacteria and yeast. Taking Lactobacillus along with medications that decrease the immune system might increase the chances of getting sick.

Are there interactions with herbs and supplements?

Are there interactions with foods?

What dose is used?

The strength of Lactobacillus products is usually indicated by the number of living organisms per capsule. Typical doses range from 1 to 10 billion living organisms taken daily in 3-4 divided doses.

The following doses have been studied in scientific research:

ADULTS:

BY MOUTH:

For hayfever: At least 2 billion Lactobacillus paracasei daily for 7 weeks has been used along with 10 mg of loratadine once daily for 5 weeks.

For preventing diarrhea caused by antibiotics: A specific beverage (Actimel, Danone) containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus (Actimel, Danone) 97 mL has been taken twice daily. Also, a combination of Lactobacillus acidophilus LA-5 and Bifidobacterium BB-12, a total of 2 billion live cells, has been taken twice daily for 14 days.

For eczema (atopic dermatitis): A specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle), has been used. Also, 100 million CFU of Lactobacillus reuteri has been used daily starting at week 36 of pregnancy until delivery.

For a condition associated with an increased risk for developing allergic reactions (atopic disease): Ten to 20 billion CFU of Lactobacillus GG has been used daily for 2-4 weeks before delivery.

For treating vaginal infections caused by bacteria (bacterial vaginosis): 150 mL of yogurt containing Lactobacillus acidophilus has been used daily for 2 months.

For preventing diarrhea due to cancer treatment (chemotherapy): Ten to 20 billion CFU of a specific strain of Lactobacillus rhamnosus, Lactobacillus GG, has been used daily in two divided doses during 24 weeks of chemotherapy.

For Helicobacter pylori (H pylori) infection: A yogurt containing one billion CFU Lactobacillus gasseri has been used twice daily for 4 to 8 weeks alone or with antibiotics. A specific product (Lacteol Fort, Bruschettini s.r.l., Genoa, Italy) containing Lactobacillus acidophilus has been taken three times daily for 10 days along with antibiotics. Other combinations of Lactobacillus strains and antibiotics have also been used.

For high cholesterol: A mixture of three strains of Lactobacillus plantarum containing a total daily dose of 1.2 billion live cells has been used for 12 weeks. Also, specific yogurt or specific capsules containing 2.9 to 50 billion live cells of Lactobacillus reuteri (strain NCIMB 30242; Cardioviva, Micropharma Limited) have been used daily for 6 to 9 weeks.

For irritable bowel syndrome (IBS): A specific product containing 10 billion organisms of Lactobacillus acidophilus (Lacteol Fort) has been used daily for 6 weeks. Also, a specific beverage containing Lactobacillus plantarum (ProViva, Skanemejerier, Sweden) has been taken in doses of 125-200 mL once or twice daily, or capsules containing 10 billion CFU Lactobacillus plantarum once daily, for 4 weeks.

For inflamed mouth sores from cancer treatment (oral mucositis): Lozenges containing Lactobacillus brevis have been dissolved in the mouth every 2-3 hours up to six times daily during chemotherapy and continuing until one week after.

Inflammation of an artificial rectum surgically created in people with inflammatory bowel disease (pouchitis): A combination probiotic containing, Lactobacillus, Bifidobacterium, and Streptococcus species (VSL#3), has been taken twice daily for up to one year. A specific formulation (Trilac, Allergon AB, Angelholm, Sweden) containing Lactobacillus acidophilus, Lactobacillus bulgaricus, and Bifidobacterium bifidum, has been taken in doses of two capsules three times daily for 9 months.

For rheumatoid arthritis: One hundred million CFU of Lactobacillus casei have been used daily for 8 weeks.

For traveler's diarrhea: Two billion CFU of a specific strain of Lactobacillus rhamnosus, Lactobacillus GG, has been used daily, starting two days before traveling and continuing until the end of the trip.

For a bowel condition called ulcerative colitis: A specific product (Profermin, Nordisk Rebalance), containing 100 million colony forming units (CFUs)/mL of the specific probiotic strain Lactobacillus plantarum has been taken twice daily for 8 weeks. Also, 3 grams of another combination probiotic containing Lactobacillus, Bifidobacterium, and Streptococcus (VSL#3) has been used twice daily for maintenance therapy.

APPLIED INSIDE THE VAGINA:

For treating vaginal infections caused by bacteria: One to two vaginal tablets (Gynoflor, Medinova, Switzerland) daily containing living Lactobacillus acidophilus (10 million colon-forming units/tablet) and 0.3 mg estriol for 6 days. Intravaginal suppositories containing 100 million to 1 billion colony forming units of Lactobacillus acidophilus (Vivag, Pharma Vinci A/S, Denmark) given twice daily for 6 days has also been used.

CHILDREN:

BY MOUTH:

For children with rotaviral diarrhea: Five to 10 billion live Lactobacillus GG in a solution that replaces lost water has been used. Also, 10 to100 billion live Lactobacillus reuteri daily for up to 5 days has been used. Lower doses might not be as effective.

For hayfever: Ten billion cells of Lactobacillus johnsonii, has been taken once daily for 12 weeks along with 5 mg of levocetirizine in children 7-12 years-old.

For preventing diarrhea caused by antibiotics: While taking antibiotics, 10-20 billion live organisms of a strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle), has been taken once daily or 20 billion organisms twice daily.

For eczema (atopic dermatitis): Five billion CFU of Lactobacillus sakei has been used twice daily for 12 weeks. Also, 100 million CFU of Lactobacillus reuteri daily from birth to 12 months has been used. Fifty billion CFU of Lactobacillus plantarum has been used twice daily for 12 weeks in children aged 1 to 13 years.

For a condition associated with an increased risk for developing allergic reactions (atopic disease): Ten to 20 billion CFU of Lactobacillus GG has been used daily for the first three to six months of life.

For diarrhea: Six billion CFU of a specific strain of Lactobacillus rhamnosus, Lactobacillus GG, has been used twice daily in infants while hospitalized. Also, 37 billion CFU of Lactobacillus GG has been used daily, 6 days weekly, for 15 months in children 6 to 24 months-old.

For Helicobacter pylori (H pylori) infection: A combination of 94 billion CFU Lactobacillus acidophilus and 8.6 billion CFU Bifidobacterium bifidum have been used together with an antibiotic daily for 2 weeks, followed by the probiotics alone for an additional 4 weeks.

For colic in babies: One hudred million CFU of Lactobacillus reuteri (Probiotic Drops, BioGaia AB) has been used daily for up to 90 days in breast-fed and formula-fed infants.

For lung infections: Milk products containing 1 million to 5 billion CFU of various Lactobacillus strains have been used.

For traveler's diarrhea: Two billion CFU of a specific strain of Lactobacillus rhamnosus, Lactobacillus GG, has been used daily, starting two days before traveling and continuing until the end of the trip.

For a bowel condition called ulcerative colitis: A combination probiotic containing 450 billion to 1800 billion bacteria, including Lactobacillus, Bifidobacterium, and Streptococcus (VSL#3), has been used daily in children with moderate-to-severe ulcerative colitis.

This copyrighted, evidence-based medicine resource is provided by Natural Medicines Comprehensive Database Consumer Version. Natural Medicines Comprehensive Database disclaims any responsibility related to consequences of using any product. This monograph should not replace advice from a healthcare professional and should not be used for the diagnosis or treatment of any medical condition.